Health Committee on Feb. 16th, 2022

[Linda Silas]

On the question of internationally educated health care professionals, yes, it's a college issue and a provincial and territorial issue.

You might remember about seven to eight years ago Canada went to an American-based NCLEX exam to pass for RNs. We approached the premiers of each province and territory saying that they had made a mistake. One, it's going to make it a lot easier to attract nurses to go to the U.S., and, two, too many are failing, and especially in the French language. All the ministers of health said that it was out of their hands because they gave them total accountability and responsibility on that. We have to go back to the health ministers and the regulatory college to fix how they enter and evaluate internationally educated foreign nurses or others. That's the key. What the federal government can do is, again, bring best practices to the provinces and territories. It is crucial to do that.

We'll send you a brief. We'll also be presenting to the FINA committee that we need bridging programs. We were working on bridging programs in the early 2000s. A lot of you went back to the 1990s. I started it. But in 2004 we had a health accord that all the premiers and prime minister agreed on. Paul-Émile will remember it was signed at 1:30 a.m., in September 2004, where we looked at where the money was going to go and how it was going to increase 6% per year.

We can do it. We need bridging programs for personal care workers who want to become licensed practical nurses, and licensed practical nurses who want to become RNs, and so on. That's how we build skills for our current workforce and our future workforce.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Dr. Smart, I heard from my constituents about Canadians who attend medical school here but have difficulty finding residencies. Sometimes they have to go to the U.S. to find a position in residency. I heard you say there are bureaucratic or credential barriers. Can you explain how the federal government can play a role in that?

[Dr. Katharine Smart]

Thank you for the question.

I think there are two aspects to what you're asking.

One is the training opportunities for Canadian-trained medical students to enter the residency training process that's required to become a practising physician in Canada. Again, this is part of the issue with not having a national integrated workforce plan. There isn't necessarily coordination of the number of spots available in medical school relative to the number of post-medical school training opportunities. That mismatch does create...some people who have trained to be physicians, but then aren't able to access that next step of training to allow them to actually practise. That, again, needs to be part of a plan, and we believe a national lens on that would be helpful.

The other piece I think you're talking about is the regulatory structural barriers for international medical trainees who are physicians from other countries, who are entering Canada and unable to work. Again, there are really two issues there. The first is the cost involved in accessing a Canadian licence, the training and apprenticeship process that foreign-trained physicians often need to access to be qualified here. That is very challenging. The second is that it's very cost prohibitive, and there are lots of barriers in terms of allowing people to access that system. there is, again, the fact that because this is regulated by the provinces and territories, the approach to credentialling and what's required to obtain the licence is different in every province and territory. Again, there's no singular structure, and that creates a lot of unnecessary challenges and barriers at the regulatory level.

I think the opportunity for the federal government would be to provide that support, whether it's through bursaries or other monetary supports, to allow foreign-trained physicians that training and the financial support needed to be able to access it. It's upscaling the availability of those opportunities, and it's creating a pan-Canadian approach to credentialing and what those requirements are for Canadian licensure so we're not having these individual provinces and territories creating regulatory barriers for foreign-trained providers.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Smart and Ms. Sidhu.

Next we're going to Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

Again, thank you to the witnesses.

Perhaps you could provide a quick answer to this, please, Dr. Smart. I'm wondering, with the advocation for a pan-Canadian licence, are you suggesting we get rid of provincial colleges and registrars?

[Dr. Katharine Smart]

Thank you for the question.

No, I don't think we're suggesting that, but I think what we would like to see is better coordination, with one national standard that every Canadian physician can be umbrellaed under, with ongoing co-operation and coordination at that provincial and territorial level, which will still be important from a regulatory perspective.

We do believe that there are opportunities to have that pan-Canadian licence with the coordination of existing structures and also in being able to break down some of those barriers so that you aren't necessarily having to seek licensure in each individual province independently.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Unfortunately, as a physician, it sounds like another layer of bureaucracy to me, but that's just me.

Dr. Soulez, we've talked a lot here about virtual care and perhaps the utility thereof. Do you see any difficulties, sir, as it relates to your profession as a radiologist in terms of more virtual care, perhaps, that primary care physicians or teams are using?

[Dr. Gilles Soulez]

That's actually a very good question. It's clear that the virtual care definitely increased the load of imaging, because the physicians are not examining their patients. We are seeing more ultrasounds and more CTs. This is something we need to take into consideration when we do virtual care.

In terms of this increase in imaging demand, we cannot address that. We are behind schedule and, more than ever, it's very important to improve the guidelines and the reference guidelines in being sure that every examination is relevant.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, sir. I appreciate that.

Monsieur Cloutier, you talked a bit in your original statement about immigration. I wonder if we're noting any specific holdups at the federal government level. Certainly, as members of Parliament, we understand the deluge of cases of immigration holdups, and I wonder if you have any comments specifically on how that relates to health care professionals wanting to come to Canada.

[Paul-Émile Cloutier]

It's an excellent question. If you don't mind, I'll pass it on to my colleague Elaine Watson to respond.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you.

[Elaine Watson]

Thank you for that.

I think I would give an answer that is similar to the previous one. I think that if there were an ability to expedite health care workers who have been identified to have the skills, knowledge and experience to fill the positions that we have available in Canada, that we could expedite their entry into the country and minimize the bureaucracy related to the licensure, so that we can start that process before—

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Excuse me. If I might just interrupt you there, I apologize.

I know that obviously there are strategies. Do you know specifically that we are encountering delays with respect to immigration as it pertains to health care providers? Do you have any data on that?

[Elaine Watson]

Yes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

We are.

Do we know how long the delays are?

[Elaine Watson]

I can't answer that question right here. I can tell you that they are significant.

It obviously has slowed down during COVID because of the barriers that vaccines and entry into the country have created, so I would say that it's not necessarily an issue right now, but it is something that we're going to have to pay attention to with the deluge of exits and retirements, etc., that we're going to see once the pandemic is dealt with.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Right. Thank you for that.

Ms. Silas, I'm wondering about us accrediting programs abroad. I understand that currently the National Nursing Assessment Service is an accreditation service that is actually outsourced to the United States. I wonder if that is true and what the likelihood is of us sending accreditation teams to, say, nursing programs abroad.

[Linda Silas]

Yes, it is true. Some provinces are sending accreditation teams outside and abroad for nursing programs, mostly in the Philippines. That exists. Some provinces believe that's the way they're going to fix the shortage. I can tell you now that it will not. We need to work on a better and broader pan-Canadian health human resource strategy to do it.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you.

Mr. Barua, I don't think we have too much time. Do you have any ideas, sir, about the cost barriers to educating health care providers in Canada?

[Bacchus Barua]

Unfortunately, that's not something I've looked at [Technical difficulty—Editor].

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Dr. Smart, do you have any comments on that?

[The Chair, Liberal, Sean Casey]

Make it a brief answer if you could, please, Dr. Smart.

[Dr. Katharine Smart]

One of the things we know is that there are huge costs to obtaining training in medicine. That can be a real barrier when you look at diversity in terms of who enters the medical profession right now, and that then, of course, goes on to where people choose to ultimately practice. I do think that those cost barriers do have an impact.

[The Chair, Liberal, Sean Casey]

Thank you.

Dr. Powlowski, please, for five minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

I'll start by commenting that Mr. Lake said he started voting NDP, and as he got older and presumably a little wiser, he joined the PCs. Maybe with a couple more years and a little more wisdom, eventually he'll become a Liberal.

Following on from that, Mr. Barua, you talked about underfunding of the system. It seems pretty clear that you think that's a large part of the problem. What are we going to do about it? That is the question. How accepting are Canadians going to be of higher taxes in order to pay for higher health care?

Luc talks repeatedly about the need for more money going to Quebec in order to provide adequate health care in Quebec. I think other provinces feel the same way. However, how much are Canadians willing to pay?

You've talked about user fees and the option of private health care, which both seem to be prohibited under the Canada Health Act. Should we allow those things?

There have been a number of surveys where people have asked Canadians what the most important thing is for them in defining what a Canadian is, or what the most important value is as a Canadian. Most Canadians repeatedly say two things: hockey and universal health care. Clearly, of those, the more important one is hockey, but health care comes in a pretty close second.

Would Canadians be willing to countenance user fees and privatization of health care? We're all politicians here. Basically, would this sell in Canada?

Do you think Canadians would be willing to accept that? Is any party going to have the cojones to do that, and is this something that we might need a national referendum on?